2023-11-14T16:22:42+00:00 2022-12-31 990 2022-01-01 815174295 Indiana University Health Frankfort Inc INDI 3179634842 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 TODD A WILLIAMS CFO 2023-11-14 TODD WILLIAMS 999009999 2022 2023-04-26 12:10:37Z ARTHUR VASQUEZ 950 N MERIDIAN STREET 1200 INDIANAPOLIS IN 46204 30741238 false X HTTPS://IUHEALTH.ORG/FIND-LOCATIONS/IU-HEALTH-FRANKFORT-HOSPITAL X 2017 IN Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. 14 9 184 64 0 0 320613 211287 34710090 30635292 13084 -107909 22663 2568 35066450 30741238 4985 1984 0 9764258 10982579 0 0 17772418 18767738 27541661 29752301 7524789 988937 38390690 36751477 44706048 42077898 -6315358 -5326421 Lead the transformation of healthcare through quality, innovation & education, and make Indiana one of the nation's healthiest states. false false 28344433 1984 30635292 Indiana University Health Frankfort, Inc. (IU Health Frankfort Hospital), located in Frankfort, Indiana, opened a new, replacement hospital in 2020. The new patient-experience-centered hospital is a single-story facility that is approximately 48,000 square -feet. IU Health Frankfort Hospital offers a comprehensive range of healthcare services that includes 24-hour emergency care, laboratory and imaging services, surgical suites, physical and occupational therapy, as well as prenatal, cardiovascular, and pulmonary services. 28344433 true true false true false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true false false true 0 0 184 true false false false false false false false false false false false false X 14 9 false false false false true true true true true false false true true true true true true true true false IN X CRAIG J JONES 3179634842 950 N MERIDIAN STREET SUITE 800 INDIANAPOLIS IN 46204 DAVID HUMMELS DIRECTOR/CHAIR (PART YEAR) 2.0 4.0 X X 0 1500 0 GARY D HENRIOTT DIRECTOR/CHAIR (PART YEAR) 2.0 5.0 X X 0 6750 0 AMANDA WHITLOCK DIRECTOR 2.0 4.0 X 0 3750 0 ERIKA UGIANSKIS MD DIRECTOR 2.0 53.0 X 0 739272 74127 JESSE MOORE DIRECTOR 2.0 4.0 X 0 9000 0 MARION UNDERWOOD DIRECTOR (PART YEAR) 2.0 4.0 X 0 0 0 MARK BUONO MD Director 2.0 53.0 X 0 659611 51239 MICHELE S SAYSANA MD DIRECTOR 2.0 53.0 X 0 569965 19743 RANDALL R MITCHELL DIRECTOR 2.0 4.0 X 0 18750 0 RANDY W PRICE DIRECTOR 2.0 4.0 X 0 9000 0 REV KATE L WALKER DIRECTOR 2.0 4.0 X 0 13500 0 RUBAN NIRMALAN MD DIRECTOR 2.0 53.0 X 0 806165 60121 SHAN SHERIDAN DIRECTOR 2.0 4.0 X 0 9000 0 UMESH PATEL DIRECTOR (PART YEAR) 2.0 4.0 X 0 2000 0 VICTOR L LECHTENBERG DIRECTOR (PART YEAR) 2.0 4.0 X 0 1500 0 WILLIAM Y LI MD DIRECTOR 2.0 53.0 X 0 336285 37439 ARTHUR VASQUEZ REGIONAL PRESIDENT (WCR) 10.0 45.0 X 0 592106 122681 KRISTIN POST INTERIM PRESIDENT (PART YEAR) 20.0 30.0 X 0 181509 37428 PHILIP LIST SECRETARY (WCR) 10.0 45.0 X 0 183142 46537 TODD A WILLIAMS CFO/TREASURER (WCR) 10.0 45.0 X 0 331667 67328 ALLISON SHUTTZ CNO (PART YEAR) 10.0 45.0 X 0 450214 51218 CHRISTOPHER A MANSFIELD MD VP-CMO (WCR) 10.0 45.0 X 0 519089 67170 JEFFREY C ZEH COO (WCR) 10.0 45.0 X 0 367543 39284 KISHAN PATEL MD VP-Chief Physician Executive (WCR) (Part Year) 10.0 45.0 X 0 411678 40797 KOREEN C KYHNELL VP - HUMAN RESOURCES (WCR) 10.0 45.0 X 0 229165 67740 CHRISTEN N BARKER Clinical Nurse 50.0 0 X 147055 0 36439 JAN EARLY Therapist-Respiratory Registered 50.0 0 X 139879 0 21784 JERRY W DRUMMOND Technologist-Diagnostic Radiology Advanced 50.0 0 X 187141 0 18623 MACEY PARKER CLINICAL NURSE 50.0 0 X 157782 0 13910 TRACY MOORE Therapist-Respiratory Registered 50.0 0 X 135272 0 36282 CARA L BREIDSTER FORMER OFFICER 0.0 55.0 X 0 338130 66652 DANIEL E NEUFELDER FORMER OFFICER 0.0 0.0 X 0 188587 0 DEREK E EMPIE FORMER OFFICER 0.0 55.0 X 0 311467 61837 JAMES H PARSONS FORMER HIGHEST COMPENSATED EMPLOYEE 10.0 35.0 X 0 192093 46116 LAWRENCE STAUFFER FORMER HCE 0.0 0 X 0 161728 46848 767130 7644167 1131343 21 true true false 0 169765 41522 211287 NET PATIENT SERVICE REVENUE 622110 30635292 30635292 0 0 0 0 30635292 -107909 -107909 0 0 0 0 OTHER OPERATING REVENUE 900099 2568 2568 0 0 0 0 2568 30741238 30635292 0 -105341 X 1984 1984 9123947 8827576 296371 267137 258460 8677 1045304 1011350 33954 546191 528449 17742 1296 1296 9441414 8678802 762612 0 10215 9390 825 36352 18176 18176 483552 483552 12991 11942 1049 3763 3459 304 1527527 1527527 1937367 1853288 84079 123742 123742 BAD DEBT 1349904 1349904 DRUGS AND MEDICAL SUPPLIES 1662713 1662713 HOSPITAL ASSESSMENT FEE 1445956 1445956 730946 671905 59041 0 29752301 28344433 1407868 0 6288828 6306661 0 0 0 0 327560 369635 49735 58467 38751235 8734521 31724567 30016714 0 0 0 0 38390690 36751477 7167165 2808096 0 0 37538883 39269802 44706048 42077898 -6315358 -5326421 -6315358 -5326421 38390690 36751477 988937 0 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1296 1296 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY IU Health Frankfort, Inc. paid institutional membership dues to the American Hospital Association ("AHA") and Indiana Hospital Association ("IHA") during 2022 in the amount of $3,700 and $3,674, respectively. Each membership organization notified IU Health Frankfort that a portion of the dues it paid were used for lobbying purposes. The AHA used 26.47%, or $979 of 2022 membership dues paid by IU Health Frankfort for lobbying expenditures. The IHA used 8.63%, or $317 of the 2022 membership dues paid by IU Health Frankfort, for lobbying expenditures. The total membership dues paid to these organizations by IU Health Frankfort during 2022 that were attributable to lobbying expenditures was $1,296. 1030133 1030133 27513288 1616594 25896694 452991 452991 0 9257007 6562795 2694212 497816 102141 395675 30016714 INTERCOMPANY PAYABLES (NET) 37240381 DUE TO THIRD PARTY PAYERS 2029421 39269802 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote IU HEALTH FRANKFORT, INC. IS A SUBSIDIARY IN INDIANA UNIVERSITY HEALTH, INC.'S ("IU HEALTH") CONSOLIDATED AUDITED FINANCIAL STATEMENTS. The Internal Revenue Service has determined that Indiana University Health and certain of its affiliated entities are tax-exempt organizations as defined in Section 501(c)(3) of the Internal Revenue Code (IRC). Indiana University Health and its tax-exempt affiliates are, however, subject to federal and state income taxes on unrelated business income under the provisions of IRC Section 511. Deferred income taxes that, as of December 31, 2022 and 2021, have no net carrying value reflect the net tax effect of temporary differences between the carrying amounts of assets and liabilities for financial reporting and the amounts used for income tax purposes. As of December 31, 2022 and 2021, the Indiana University Health System had gross deferred tax assets of $145,194,000 and $146,281,000, respectively, primarily relating to net operating loss carryovers. Management determined that a full valuation allowance at December 31, 2022 and 2021, was necessary to reduce the deferred tax assets to the amount that would more likely than not be realized. Based on the weight of the evidence, if it is more likely than not that some portion or all of the deferred tax assets will not be realized, a valuation allowance to reduce the deferred tax assets is recorded. At December 31, 2022, Indiana University Health System has available net operating loss carryforwards of $583,788,000. Net operating losses generated from 2001 through 2017 will expire between 2022 and 2037. Net operating losses generated after 2017 do not expire. true true X true X 300 false true true false true true 1204 647203 0 647203 0.0228 3500 7729338 5184298 2545040 0.0896 0 0 0 0 0.0 0 4704 8376541 5184298 3192243 0.1124 1 201 604192 0 604192 0.0213 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 1 0 1662 0 1662 0.0001 2 201 605854 0 605854 0.0213 2 4905 8982395 5184298 3798097 0.1337 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 false 483671 0 6731610 6600936 130674 X true true 1 1 IU HEALTH FRANKFORT HOSPITAL 1300 S JACKSON STREET FRANKFORT IN 46041 HTTPS://IUHEALTH.ORG/FIND-LOCATIONS/IU-HEALTH-FRANKFORT-HOSPITAL 23-005039-1 X X X X IU HEALTH FRANKFORT HOSPITAL 1 false false true X X X X X X X X X 21 true false false true X HTTPS://IUHEALTH.ORG/IN-THE-COMMUNITY/COMMUNITY-BENEFIT true 22 true HTTPS://IUHEALTH.ORG/IN-THE-COMMUNITY/COMMUNITY-BENEFIT false true X 300.0 0.0 X X X X X X X true true X X X true X HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE X HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE X HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE X X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E IU Health Frankfort's 2021 Community Health Needs Assessment (CHNA) Report includes a prioritized description of significant health needs in the community. The CHNA report identified the following needs as priorities for IU Health Frankfort: 1. Access to Healthcare Services 2. Aging Population and Needs of Seniors 3. Behavioral Health 4. Chronic Disease and Chronic Disease Management 5. Health Education and Navigation 6. Social Determinants of Health Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - IU HEALTH FRANKFORT HOSPITAL. In conducting each its most recent CHNA, IU Health Frankfort took into account input from persons who represent the broad interests of the communities it serves by hosting two community focus groups. These events engaged public health officials and community-based organizations that provide services and/or reflect community members who are medically underserved, low-income, or of a minority subpopulation to discuss the health needs of the service area and what role IU Health could play in addressing the identified needs. IU Health Frankfort The defined community per the most recent CHNA is Clinton County, Indiana, where the hospital resides. Clinton County - Community Meetings Two community meetings were held in 2021 to receive input from stakeholders regarding the health needs in Clinton County - one on April 14 and another on April 22. Secondary data and a preliminary list of community health need priorities was presented at both meetings. Each group was then asked questions about the preliminary list, including their reactions, additions to the proposed needs, thoughts regarding the causes, impacts of the COVID-19 pandemic and others. After these discussions, participants were given the opportunity to make additional comments before being asked to vote on the significant needs in the county. Participants were asked to choose three to five significant health needs in a poll during the meeting until each group was able to reach some consensus regarding the priority needs. Preliminary needs identified include a variety of topics, including poor or fair health status, obesity, physical inactivity, teen births, uninsured residents and educational achievement. In addition to these topics, participants focused discussion on mental health, child abuse and Adverse Childhood Experiences (ACEs), housing, transportation, substance abuse, cultural barriers to care (such as language and health not being a priority), food insecurity, maternal and infant health, obesity, diabetes, access to primary care and others. From this process, participants from the April 14 community meeting identified the following needs as most significant for Clinton County: * Mental health * Substance abuse * Transportation barriers * Health insurance and uninsured residents * Housing affordability and availability Participants from the April 22 community meeting identified the following needs as most significant for Clinton County: * Mental health * Cultural barriers to care (cultural awareness and language) * Substance abuse * Transportation In discussing the impacts of the COVID-19 pandemic on health, participants focused on the disproportionate impact on Hispanic (or Latino) residents due to cultural and language barriers, isolation and mental health impacts (including among children), increased difficulties in housing and food access, financial impacts of unemployment, technology barriers and a digital divide, increased domestic violence and abuse and difficulty accessing care. An additional community survey was issued to stakeholders unable to attend community meetings, asking them to identify priority needs. Among 24 responses, the following issues were identified as the most significant: * Substance abuse * Mental health * Access to healthcare services * Obesity, nutrition and physical inactivity * Cultural competency in care, including language barriers The survey also asked about the impacts of the COVID-19 pandemic. Issues most often selected as significant impacts include: * Social isolation and loneliness * Learning and development impacts among children * Poverty * Lack of access to healthcare services * Digital divide (lack of internet or device access) * Loss of health insurance * Unemployment or underemployment * Childcare access and costs Community meeting and survey participants Individuals from a wide variety of organizations and communities participated in community meetings and surveys. Participants included representatives from the following organizations: * Anthem * Bauer Family Resources * Four County * COACH Kids of Clinton County * Clinton Central School Corporation * Clinton County Sheriff's Office * Clinton County Boys and Girls Club * Clinton County Family YMCA * Clinton County Health Department * Clinton Prairie High School * City of Frankfort * Crossing Frankfort * Frankfort Community Public Library * Healthy Communities of Clinton County (HCCC) Coalition * Heartford House Child Advocacy Center * IU Health * IU Health Frankfort * Indiana Professional Management Group (IPMG) * Learning Network of Clinton County * NAMI West Central Indiana * North Central Health Services * Nurse-Family Partnership * Paul Phillippe Resource Center * Purdue Extension * The Learning Network of Clinton County * United Way for Clinton County Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - IU HEALTH FRANKFORT HOSPITAL. Along with the CHNA, IU Health Frankfort's Board adopted an implementation strategy in April 2022 in response to the 2021 CHNA. IU Health Frankfort, along with community partners, prioritized and determined which of the significant needs identified in its most recently conducted CHNA could be adequately addressed by current or future initiatives, programs, resources, and collaborations. The 2022-2024 implementation strategy outlines how IU Health Frankfort plans to address significant needs including initiatives, strategies, internal/external collaborators, anticipated impact, and hospital resources. Significant Needs Hospital Will Address Below is the progress of the implementation strategy by significant need and its respective initiative(s). The hospital is addressing the following significant needs between 2022 and 2024: Access to Healthcare Services; Aging Population and Needs of Seniors; Behavioral Health; Chronic Disease and Chronic Disease Management; Health Education and Navigation; and Social Determinants of Health. Access to Healthcare Services - Support the Open Door Clinic (provides free or discounted healthcare services in the community). - In 2022, the ODC referred 470 patients to IU Health Frankfort for covered services for a total value of $51,704. - Create a pipeline, targeting youth and adults, for future healthcare leaders to access local opportunities. - HR representatives from IU Health presented about healthcare careers to local high schools. - Support community members accessing healthcare services regardless of their ability to pay. - IU Health Frankfort provides financial assistance to patients each year. - Provide increased access to obstetrics and gynecology (OB/GYN) services. - OB/GYN services provided locally once a week, serving approximately 1,800 patients in 2022. - Launch Integrated Social Work Initiative in IU Health clinical settings. - This program is no longer offered in the West Central Region. Aging Population and Needs of Seniors - Further implement IU Health Safe Medication Disposal Program. - IU Health Frankfort continues to be a site for safe medication disposal. - Coordinate local community outreach activities to senior population. - IU Health donated water bottles to the Frankfort Senior Games participants. During the 2022 WILO Senior Fair, IU Health was an event sponsor and provided screenings to participants. Behavioral Health - Further implement Virtual Care Peer Recovery Coaching Program (provides patients with substance use concerns virtual behavioral health services). - In 2022, IU Health Frankfort served 41 new patients for the peer recovery coaching services. Eleven were repeat patients. There is a total of 1,029 active patients. Peer recovery coaches spent more than 16,000 minutes with patients. - Develop hospital and community infrastructure for crisis care to support community members with mental health and substance use concerns. - IU Health collaborated with other providers in the region, as well as supported community organizations that provide assistance to community members with mental health and substance use concerns. - Support naloxone distribution in the community. - Healthy Communities of Clinton County Coalition continues to provide 24/7 access to naloxone through the NaloxBox installed at their location by IU Health in 2021. - Provide comprehensive suicide prevention through Zero Suicide Initiative. - The Zero Suicide Initiative was launched in the West Central Region (including IU Health Frankfort Hospital) in March 2022 through November 2022 when services were paused due to staffing. During that time, 44 patients were referred to the program, though none of them accepted treatment. More than 1,700 team members were trained in suicide prevention. - Further implement emergency department (ED) virtual care program (provides patients virtual access to behavioral health services). - In 2022, IU Health Frankfort provided virtual psych services to 167 patients. Fifty-five of these patients were repeat patients. Chronic Disease and Chronic Disease Management - Coordinate community outreach and education opportunities. - IU Health Frankfort team members installed a gaga ball pit at the local Boys and Girls Club to provide additional opportunity for physical activity. - IU Health Disease Management partnered with IU Health Plans team members partnered to provide All Foods Fit at the Clinton County YMCA in 2022. There were 5 participants who attended the 12-week course. - Further implement the Centralized Tobacco Treatment Program (CTTP) (provides patients access to evidence-based tobacco treatment). - The CTTP was launched in September 2022 in the WCR. There were 117 total participants. Of those 117 referrals, 55 did not continue with the program, 25 quit smoking and 37 are working on a plan to quit or are in the process of quitting. - During 2022, the IU Health Foundation provided funding for free Nicotine Replacement Therapy for those whose insurance does not cover medications or those who cannot afford this medication. - IU Health taught 3 tobacco cessation group classes at local recovery houses with 16 participants in each of these classes. Health Education and Navigation - Promote findHelp.org to connect community members to health and social services. - FindHelp.org was promoted to team member "Super Users" in the West Central Region. Community organizations were encouraged to manage their organizations' pages on the platform. - Support the Bridging the Gap. - The Bridging the Gap program was paused due to system level initiatives around language services. Social Determinants of Health - Provide fiscal support to organizations addressing social determinants of health. - IU Health offered community grants to organizations addressing social determinants of health. However, no applications were received from Clinton County in 2022. - Establish strategic collaborative relationships with local community-based organizations addressing social determinants of health. - IU Health continued its partnership with Healthy Communities of Clinton County Coalition, the Home for the Night and other organizations within Clinton County that addressed social determinants of health. - Support career pathway development program. - Team members from our human resources department visited Frankfort Crossing School in 2022 to meet with leaders about the program. Significant Needs Hospital Will Not Address IU Health Frankfort addressed all the significant health needs identified in the 2021 Community Health Needs Assessment. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - IU HEALTH FRANKFORT HOSPITAL. IN ADDITION TO FPG, IU HEALTH FRANKFORT MAY TAKE INTO CONSIDERATION A PATIENT'S INCOME AND/OR ABILITY TO PAY IN CALCULATION OF A FINANCIAL ASSISTANCE AWARD. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - IU HEALTH FRANKFORT HOSPITAL. IU Health Frankfort takes into consideration several other factors in determining patient eligibility for financial assistance. These factors include the following: 1. Eligibility for Financial Assistance due to Financial or Personal Hardship In order to be eligible for Financial Assistance due to Financial or Personal Hardship under this Policy, a patient or guarantor must: - Submit a completed Financial Assistance Application with all supporting documentation and be approved in accordance with this Policy; - Be an Indiana Resident as defined in this Policy; and - If Uninsured, consult with a member of IU Health Frankfort's Individual Solutions department to determine if health care coverage may be obtained from a government insurance or assistance product, the Health Insurance Marketplace, or from any other source of coverage. Financial Assistance due to Financial Hardship is only available for encounters where care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility. 2. Financial Assistance due to Financial Hardship The FPL income threshold under this section is as follows: - If one or more adults and zero dependents are in the household, the FPL Income Threshold is 200%. - If two or more adults and one or more dependents are in the household, the FPL Income Threshold is 250%. - If one adult and one or more dependents are in the household, the FPL Income Threshold is 300%. In some instances, an adult will also qualify as a dependent. When this occurs, IU Health Frankfort will treat the adult as a dependent for purposes of the FPL calculation. IU Health Frankfort will utilize the most recent FPL data available and will apply the FPL data to a patient or guarantor's account balance based upon the calendar date a completed Financial Assistance Application was received, not a patient's date of service. An Uninsured Patient or their guarantor whose household income is less than or equal to the FPL income threshold may be eligible for full Financial Assistance up to 100% of Gross Charges if approved. An Underinsured Patient or their guarantor whose household income is less than or equal to the FPL income threshold may be eligible for full Financial Assistance up to 100% of Patient Responsibility if approved. 3. Financial Assistance due to Personal Hardship An Uninsured or Underinsured patient or their guarantor whose household income is above the FPL income threshold may be eligible for Financial Assistance if the patient's outstanding Patient Responsibility exceeds 20% of the patient's or their guarantor's annual household income. - If approved, the patient's balance will be reduced to 20% of the patient or guarantor's annual household income or the Amounts Generally Billed, whichever is less. - IU Health Frankfort will work with the patient or guarantor to identify a reasonable payment plan on the remainder of the balance. 4. Eligibility Period If approved for financial assistance by IU Health, the patient will be guaranteed financial assistance for treatment related to the underlying condition, for which the patient was originally screened and approved, through the remainder of the calendar year. As a condition of extending the on-going Financial Assistance, the patient must comply with requests from IU Health Frankfort to verify that the patient continues to meet the conditions for qualification. 5. Appeals and Assistance Granted By the Financial Assistance Committee The Financial Assistance Committee will review and make determinations on all requests for appeals related to Financial Assistance. If a patient or guarantor seeks to appeal a Financial Assistance Determination, a written request must be submitted, along with the supporting documentation. The Financial Assistance Committee will review requests for and may grant additional Financial Assistance, including but not limited to, the following: - Assistance to patients who are seeking treatment that can only be provided in Indiana by IU Health Frankfort or who would benefit from continued medical services from IU Health Frankfort for continuity of care; - Care approved by the IU Health Chief Medical Officer (CMO) or the Chief Executive Officer (CEO) or CMO of an IU Health facility or region, including medically necessary non-elective services for which no payment source can be identified; - Care provided when it is known no payment source exists; - International humanitarian aid; and - Other care identified by the Financial Assistance Committee that fulfills the IU Health Mission. All decisions of the Financial Assistance Committee are final. 6. Presumptive Eligibility No Financial Assistance Application is required to receive Financial Assistance under this Presumptive Eligibility section. IU Health Frankfort will deem patients or their guarantors presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs and care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility: - Medicaid (any state) - Indiana Children's Special Health Care Services - Healthy Indiana Plan - Patients who are awarded Hospital Presumptive Eligibility (HPE) - A state and/or federal program that verifies the patient or guarantor's gross household income meets the FPL income threshold. IU Health will conduct a quarterly review of all accounts placed with a collection agency partner for at least one hundred and twenty (120) days after the account is eligible for an ECA as set forth in this Policy. If the patient or guarantor's individual scoring criteria demonstrates the patient has a low likelihood and/or propensity to pay or no credit, the patient or guarantor may be deemed presumptively eligible for Financial Assistance. Financial Assistance may additionally be granted in the following circumstances: - If the patient or their guarantor is found to have filed a petition for bankruptcy. - If the patient is deceased and found to have no estate. - If the patient is deceased and was under 21 years of age at the time of death. 7. Exhaustion of Alternate Sources of Assistance Patients must exhaust all other state and federal assistance programs prior to receiving Financial Assistance due to Financial or Personal Hardship under this Policy including, but not limited to, Medicaid. Patients who may be eligible for coverage under an applicable health insurance policy must exhaust all insurance benefits. - This includes patients covered under their own policy and those who may be entitled to benefits from a third-party policy. - IU Health may request patients show proof that such a claim was properly submitted to the appropriate insurance provider before awarding Financial Assistance. Eligible patients who receive medical care from an IU Health facility as a result of an injury proximately caused by a third party, and later receive a monetary settlement or award from said third party, may receive Financial Assistance for any outstanding balance not covered by the settlement or award. In the event Financial Assistance has already been granted in the above circumstances, IU Health reserves the right to reverse the Financial Assistance Determination in an amount equal to the amount IU Health would be entitled to receive had no Financial Assistance been awarded. 8. Patient Assets There are situations where a patient or their guarantor may have significant income or assets available to pay for healthcare services such as a legal settlement. The Financial Assistance Committee may evaluate the income or assets in determining Financial Hardship. IU Health Frankfort may require a list of all property owned by the patient or guarantor and adjust a Financial Assistance Determination as a result. Schedule H, Part V, Section B, Line 16 Facility , 1 Facility , 1 - IU HEALTH FRANKFORT HOSPITAL. IU HEALTH FRANKFORT TAKES SEVERAL OTHER MEASURES TO PUBLICIZE ITS FAP WITHIN THE COMMUNITY. THESE MEASURES INCLUDE THE FOLLOWING: 1. Post this Policy, a Plain Language Summary of this Policy, and the Financial Assistance Application on its website. 2. Provide patients with a Plain Language Summary of this Policy during registration and/or discharge. 3. Post conspicuous displays in appropriate acute care settings such as emergency departments and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 4. Include a conspicuous written notice on all patient post-discharge billing statements notifying the patient about this Policy and the telephone number of the Customer Service Department which can assist patients with questions regarding this Policy. 5. Make available Customer Service representatives via telephone during normal business hours. 6. Mail copies of this Policy, a Plain Language Summary of this Policy, and a Financial Assistance Application to patients or their guarantor free of charge upon request. 7. Broadly communicate this Policy as a part of its general outreach efforts. 8. Educate patient-facing team members on this Policy and the process for referring patients to the program. 2 IU HEALTH FRANKFORT LAB 1300 S Jackson St FRANKFORT IN 46041 LAB IU HEALTH FRANKFORT PAIN MANAGEMENT 1458 S Jackson St FRANKFORT IN 46041 Specialty Care Schedule H, Part I, Line 6a REPORT PREPARED BY A RELATED ORG. IU Health Frankfort's community benefit and other investments, encompassing its total community investment, are included in the IU Health Community Benefit Report which is prepared on behalf of and includes IU Health and its related hospital entities in the State of Indiana. The IU Health Community Benefit Report is made available to the public on IU Health's website at https://iuhealth.org/in-the-community. The IU Health Community Benefit Report is also distributed to numerous key organizations throughout the State of Indiana in order to broadly share the IU Health Statewide System's community benefit efforts. It is also available by request through the Indiana State Department of Health or IU Health. Schedule H, Part I, Line 7f PERCENT OF TOTAL EXPENSE The amount of bad debt expense included on Form 990, Part IX, Line 25, column (A), but subtracted for purposes of calculating the percentage of total expense on Line 7, column (f) is $1,349,904. Bad debt expense is reported at cost based on the cost-to-charge ratio derived from worksheet 2, ratio of patient care cost-to-charges. Schedule H, Part I, Line 7 TOTAL COMMUNITY BENEFIT EXPENSE Schedule H, Part I, Line 7, Column (f), Percent of Total Expense, is based on column (e) Net Community Benefit Expense. The percent of total expense based on column (c) Total Community Benefit Expense, which does not include direct offsetting revenue, is 31.63%. Schedule H, Part II PROMOTION OF HEALTH IN COMMUNITIES SERVED IU Health Frankfort supports and/or participates in a variety of community-building activities that address the non-medical, root causes of health problems in the communities it serves. IU Health Frankfort and its related hospital entities across the state of Indiana ("IU Health Statewide System") investments include economic development efforts across the state, workforce development opportunities, collaborate with like-minded organizations through coalitions that address key issues, and advocate for improvements in the health status of vulnerable populations. Some activities meet the definition of community benefit and have been reported as such. Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care IU HEALTH USES SEVERAL FACTORS OTHER THAN FEDERAL POVERTY GUIDELINES ("FPG") IN DETERMINING ELIGIBILITY FOR FREE CARE UNDER ITS FAP. THESE FACTORS INCLUDE THE FOLLOWING: 1. ELIGIBILITY FOR FINANCIAL ASSISTANCE DUE TO FINANCIAL OR PERSONAL HARDSHIP IN ORDER TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE DUE TO FINANCIAL OR PERSONAL HARDSHIP UNDER THIS POLICY, A PATIENT OR GUARANTOR MUST: - SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION WITH ALL SUPPORTING DOCUMENTATION AND BE APPROVED IN ACCORDANCE WITH THIS POLICY; - BE AN INDIANA RESIDENT AS DEFINED IN THIS POLICY; AND - IF UNINSURED, CONSULT WITH A MEMBER OF IU HEALTH'S INDIVIDUAL SOLUTIONS DEPARTMENT TO DETERMINE IF HEALTH CARE COVERAGE MAY BE OBTAINED FROM A GOVERNMENT INSURANCE OR ASSISTANCE PRODUCT, THE HEALTH INSURANCE MARKETPLACE, OR FROM ANY OTHER SOURCE OF COVERAGE. FINANCIAL ASSISTANCE DUE TO FINANCIAL HARDSHIP IS ONLY AVAILABLE FOR ENCOUNTERS WHERE CARE WAS INITIATED VIA AN ELIGIBLE FACILITY'S EMERGENCY DEPARTMENT, DIRECT ADMISSION FROM A PHYSICIAN'S OFFICE, OR TRANSFER FROM ANOTHER HOSPITAL FACILITY. 2. FINANCIAL ASSISTANCE DUE TO FINANCIAL HARDSHIP THE FPL INCOME THRESHOLD UNDER THIS SECTION IS AS FOLLOWS: -IF ONE OR MORE ADULTS AND ZERO DEPENDENTS ARE IN THE HOUSEHOLD, THE FPL INCOME THRESHOLD IS 200%. -IF TWO OR MORE ADULTS AND ONE OR MORE DEPENDENTS ARE IN THE HOUSEHOLD, THE FPL INCOME THRESHOLD IS 250%. -IF ONE ADULT AND ONE OR MORE DEPENDENTS ARE IN THE HOUSEHOLD, THE FPL INCOME THRESHOLD IS 300%. IN SOME INSTANCES, AN ADULT WILL ALSO QUALIFY AS A DEPENDENT. WHEN THIS OCCURS, IU HEALTH NORTH WILL TREAT THE ADULT AS A DEPENDENT FOR PURPOSES OF THE FPL CALCULATION. IU HEALTH WILL UTILIZE THE MOST RECENT FPL DATA AVAILABLE AND WILL APPLY THE FPL DATA TO A PATIENT OR GUARANTOR'S ACCOUNT BALANCE BASED UPON THE CALENDAR DATE A COMPLETED FINANCIAL ASSISTANCE APPLICATION WAS RECEIVED, NOT A PATIENT'S DATE OF SERVICE. AN UNINSURED PATIENT OR THEIR GUARANTOR WHOSE HOUSEHOLD INCOME IS LESS THAN OR EQUAL TO THE FPL INCOME THRESHOLD MAY BE ELIGIBLE FOR FULL FINANCIAL ASSISTANCE UP TO 100% OF GROSS CHARGES IF APPROVED. AN UNDERINSURED PATIENT OR THEIR GUARANTOR WHOSE HOUSEHOLD INCOME IS LESS THAN OR EQUAL TO THE FPL INCOME THRESHOLD MAY BE ELIGIBLE FOR FULL FINANCIAL ASSISTANCE UP TO 100% OF PATIENT RESPONSIBILITY IF APPROVED. 3. FINANCIAL ASSISTANCE DUE TO PERSONAL HARDSHIP AN UNINSURED OR UNDERINSURED PATIENT OR THEIR GUARANTOR WHOSE HOUSEHOLD INCOME IS ABOVE THE FPL INCOME THRESHOLD MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE IF THE PATIENT'S OUTSTANDING PATIENT RESPONSIBILITY EXCEEDS 20% OF THE PATIENT'S OR THEIR GUARANTOR'S ANNUAL HOUSEHOLD INCOME. -IF APPROVED, THE PATIENT'S BALANCE WILL BE REDUCED TO 20% OF THE PATIENT OR GUARANTOR'S ANNUAL HOUSEHOLD INCOME OR THE AMOUNTS GENERALLY BILLED, WHICHEVER IS LESS. -IU HEALTH WILL WORK WITH THE PATIENT OR GUARANTOR TO IDENTIFY A REASONABLE PAYMENT PLAN ON THE REMAINDER OF THE BALANCE. 4. ELIGIBILITY PERIOD IF APPROVED FOR FINANCIAL ASSISTANCE BY IU HEALTH, THE PATIENT WILL BE GUARANTEED FINANCIAL ASSISTANCE FOR TREATMENT RELATED TO THE UNDERLYING CONDITION, FOR WHICH THE PATIENT WAS ORIGINALLY SCREENED AND APPROVED, THROUGH THE REMAINDER OF THE CALENDAR YEAR. AS A CONDITION OF EXTENDING THE ON-GOING FINANCIAL ASSISTANCE, THE PATIENT MUST COMPLY WITH REQUESTS FROM IU HEALTH TO VERIFY THAT THE PATIENT CONTINUES TO MEET THE CONDITIONS FOR QUALIFICATION. 5. APPEALS AND ASSISTANCE GRANTED BY THE FINANCIAL ASSISTANCE COMMITTEE THE FINANCIAL ASSISTANCE COMMITTEE WILL REVIEW AND MAKE DETERMINATIONS ON ALL REQUESTS FOR APPEALS RELATED TO FINANCIAL ASSISTANCE. IF A PATIENT OR GUARANTOR SEEKS TO APPEAL A FINANCIAL ASSISTANCE DETERMINATION, A WRITTEN REQUEST MUST BE SUBMITTED, ALONG WITH THE SUPPORTING DOCUMENTATION. THE FINANCIAL ASSISTANCE COMMITTEE WILL REVIEW REQUESTS FOR AND MAY GRANT ADDITIONAL FINANCIAL ASSISTANCE, INCLUDING BUT NOT LIMITED TO, THE FOLLOWING: -ASSISTANCE TO PATIENTS WHO ARE SEEKING TREATMENT THAT CAN ONLY BE PROVIDED IN INDIANA BY IU HEALTH OR WHO WOULD BENEFIT FROM CONTINUED MEDICAL SERVICES FROM IU HEALTH FOR CONTINUITY OF CARE; -CARE APPROVED BY THE IU HEALTH CHIEF MEDICAL OFFICER (CMO) OR THE CHIEF EXECUTIVE OFFICER (CEO) OR CMO OF AN IU HEALTH FACILITY OR REGION, INCLUDING MEDICALLY NECESSARY NON-ELECTIVE SERVICES FOR WHICH NO PAYMENT SOURCE CAN BE IDENTIFIED; -CARE PROVIDED WHEN IT IS KNOWN NO PAYMENT SOURCE EXISTS; -INTERNATIONAL HUMANITARIAN AID; AND -OTHER CARE IDENTIFIED BY THE FINANCIAL ASSISTANCE COMMITTEE THAT FULFILLS THE IU HEALTH MISSION. ALL DECISIONS OF THE FINANCIAL ASSISTANCE COMMITTEE ARE FINAL. 6. PRESUMPTIVE ELIGIBILITY NO FINANCIAL ASSISTANCE APPLICATION IS REQUIRED TO RECEIVE FINANCIAL ASSISTANCE UNDER THIS PRESUMPTIVE ELIGIBILITY SECTION. IU HEALTH WILL DEEM PATIENTS OR THEIR GUARANTORS PRESUMPTIVELY ELIGIBLE FOR FINANCIAL ASSISTANCE IF THEY ARE FOUND TO BE ELIGIBLE FOR ONE OF THE FOLLOWING PROGRAMS AND CARE WAS INITIATED VIA AN ELIGIBLE FACILITY'S EMERGENCY DEPARTMENT, DIRECT ADMISSION FROM A PHYSICIAN'S OFFICE, OR TRANSFER FROM ANOTHER HOSPITAL FACILITY: -MEDICAID (ANY STATE) -INDIANA CHILDREN'S SPECIAL HEALTH CARE SERVICES -HEALTHY INDIANA PLAN -PATIENTS WHO ARE AWARDED HOSPITAL PRESUMPTIVE ELIGIBILITY (HPE) -A STATE AND/OR FEDERAL PROGRAM THAT VERIFIES THE PATIENT OR GUARANTOR'S GROSS HOUSEHOLD INCOME MEETS THE FPL INCOME THRESHOLD. IU HEALTH WILL CONDUCT A QUARTERLY REVIEW OF ALL ACCOUNTS PLACED WITH A COLLECTION AGENCY PARTNER FOR AT LEAST ONE HUNDRED AND TWENTY (120) DAYS AFTER THE ACCOUNT IS ELIGIBLE FOR AN ECA AS SET FORTH IN THIS POLICY. IF THE PATIENT OR GUARANTOR'S INDIVIDUAL SCORING CRITERIA DEMONSTRATES THE PATIENT HAS A LOW LIKELIHOOD AND/OR PROPENSITY TO PAY OR NO CREDIT, THE PATIENT OR GUARANTOR MAY BE DEEMED PRESUMPTIVELY ELIGIBLE FOR FINANCIAL ASSISTANCE. FINANCIAL ASSISTANCE MAY ADDITIONALLY BE GRANTED IN THE FOLLOWING CIRCUMSTANCES: -IF THE PATIENT OR THEIR GUARANTOR IS FOUND TO HAVE FILED A PETITION FOR BANKRUPTCY. -IF THE PATIENT IS DECEASED AND FOUND TO HAVE NO ESTATE. -IF THE PATIENT IS DECEASED AND WAS UNDER 21 YEARS OF AGE AT THE TIME OF DEATH. 7. EXHAUSTION OF ALTERNATE SOURCES OF ASSISTANCE PATIENTS MUST EXHAUST ALL OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS PRIOR TO RECEIVING FINANCIAL ASSISTANCE DUE TO FINANCIAL OR PERSONAL HARDSHIP UNDER THIS POLICY INCLUDING, BUT NOT LIMITED TO, MEDICAID. PATIENTS WHO MAY BE ELIGIBLE FOR COVERAGE UNDER AN APPLICABLE HEALTH INSURANCE POLICY MUST EXHAUST ALL INSURANCE BENEFITS. -THIS INCLUDES PATIENTS COVERED UNDER THEIR OWN POLICY AND THOSE WHO MAY BE ENTITLED TO BENEFITS FROM A THIRD-PARTY POLICY. -IU HEALTH MAY REQUEST PATIENTS SHOW PROOF THAT SUCH A CLAIM WAS PROPERLY SUBMITTED TO THE APPROPRIATE INSURANCE PROVIDER BEFORE AWARDING FINANCIAL ASSISTANCE. ELIGIBLE PATIENTS WHO RECEIVE MEDICAL CARE FROM AN IU HEALTH FACILITY AS A RESULT OF AN INJURY PROXIMATELY CAUSED BY A THIRD PARTY, AND LATER RECEIVE A MONETARY SETTLEMENT OR AWARD FROM SAID THIRD PARTY, MAY RECEIVE FINANCIAL ASSISTANCE FOR ANY OUTSTANDING BALANCE NOT COVERED BY THE SETTLEMENT OR AWARD. IN THE EVENT FINANCIAL ASSISTANCE HAS ALREADY BEEN GRANTED IN THE ABOVE CIRCUMSTANCES, IU HEALTH RESERVES THE RIGHT TO REVERSE THE FINANCIAL ASSISTANCE DETERMINATION IN AN AMOUNT EQUAL TO THE AMOUNT IU HEALTH WOULD BE ENTITLED TO RECEIVE HAD NO FINANCIAL ASSISTANCE BEEN AWARDED. 8. PATIENT ASSETS THERE ARE SITUATIONS WHERE A PATIENT OR THEIR GUARANTOR MAY HAVE SIGNIFICANT INCOME OR ASSETS AVAILABLE TO PAY FOR HEALTHCARE SERVICES SUCH AS A LEGAL SETTLEMENT. THE FINANCIAL ASSISTANCE COMMITTEE MAY EVALUATE THE INCOME OR ASSETS IN DETERMINING FINANCIAL HARDSHIP. IU HEALTH MAY REQUIRE A LIST OF ALL PROPERTY OWNED BY THE PATIENT OR GUARANTOR AND ADJUST A FINANCIAL ASSISTANCE DETERMINATION AS A RESULT. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 1349904 Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount THE AMOUNT REPORTED ON LINE 2 AS BAD DEBT IS REPORTED AT COST, AS CALCULATED USING THE COST TO CHARGE RATIO METHODOLOGY. Schedule H, Part III, Line 3 Bad Debt Expense Methodology IU HEALTH FRANKFORT will deem patients or their guarantors presumptively eligible for Financial Assistance if they are found to be eligible for one of the following programs and care was initiated via an eligible facility's emergency department, direct admission from a physician's office, or transfer from another hospital facility: 1. Medicaid (any state) 2. Indiana Children's Special Health Care Services 3. Healthy Indiana Plan 4. Patients who are awarded Hospital Presumptive Eligibility (HPE) 5. A state and/or federal program that verifies the patient or guarantor's gross household income meets the FPL income threshold. No Financial Assistance Application is required to receive Financial Assistance under this Presumptive Eligibility section. IU HEALTH FRANKFORT will conduct a quarterly review of all accounts placed with a collection agency partner for at least one hundred and twenty (120) days after the account is eligible for an ECA as set forth in this Policy. If the patient or guarantor's individual scoring criteria demonstrates the patient has a low likelihood and/or propensity to pay or no credit, the patient or guarantor may be deemed presumptively eligible for Financial Assistance. Financial Assistance may additionally be granted in the following circumstances: a) If the patient or their guarantor is found to have filed a petition for bankruptcy. b) If the patient is deceased and found to have no estate. c) If the patient is deceased and was under 21 years of age at the time of death. Due to this comprehensive methodology, IU HEALTH FRANKFORT does not believe any amount of bad debt is attributable to patients who may be eligible under the financial assistance policy and no portion of bad debt is included as community benefit. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote IU HEALTH'S CONSOLIDATED FINANCIAL STATEMENTS, FOOTNOTE 5, ADDRESSES BAD DEBT EXPENSE AS FOLLOWS: The Indiana University Health System does not require collateral or other security from its patients, substantially all of whom are residents of the State, for the delivery of health care services. However, consistent with industry practice, the Indiana University Health System routinely obtains assignment of (or is otherwise entitled to receive) patients' benefits payable under their health insurance programs, plans, or policies (e.g., Medicare, Medicaid, managed care payers, and commercial insurance policies). The Indiana University Health System uses a portfolio approach to account for categories of patient contracts as a collective group, rather than recognizing revenue on an individual contract basis. The portfolios consist of major payer classes for inpatient revenue and outpatient revenue. Based on the historical collection trends and other analysis, the Indiana University Health System believes that revenue recognized by utilizing the portfolio approach approximates the revenue that would have been recognized if an individual contract approach were used. In support of its mission, the Indiana University Health System provides care to uninsured and underinsured patients. The Indiana University Health System provides charity care to patients who lack the financial resources to pay for their medical care. Financial assistance is available to qualifying uninsured and underinsured patients receiving care at an Indiana University Health System hospital location. Under its financial assistance policy, the Indiana University Health System provides medically necessary care to uninsured patients. Financial assistance up to the full amount of patient financial responsibility is available for uninsured and underinsured patients receiving care via the emergency department, direct admission from a physician's office, or transfer from another hospital. The federal poverty level (FPL) thresholds are used when determining the level of financial assistance based on household makeup. Households without dependents are eligible for assistance if household income is less than or equal to 200% FPL, two adults and at least one dependent are eligible if household income is less than or equal to 250% FPL, and households with one adult and at least one dependent are eligible if household income is less than or equal to 300% FPL. Individuals with medical bills totaling more than 20% of annual household income, regardless of FPL, qualify for catastrophic assistance and are eligible for a reduction in patient financial responsibility to 20% of annual household income. Since the Indiana University Health System does not pursue collection of these amounts, the discounted amounts are not reported as patient service revenue. The Indiana University Health System uses presumptive eligibility screening procedures for some forms of financial assistance and recognizes net patient service revenue on services provided to self-pay patients at the discounted rate at the time services are rendered. The estimated cost of charity care, using the consolidated cost to charge ratio, was $88,213,000 and $133,584,000 in 2022 and 2021, respectively. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs IU HEALTH FRANKFORT DID NOT HAVE A MEDICARE SHORTFALL FOR 2022. IU HEALTH FRANKFORT'S MEDICARE REIMBURSEMENTS, HOWEVER, ARE NORMALLY LESS THAN THE COST OF PROVIDING PATIENT CARE AND SERVICES TO MEDICARE BENEFICIARIES AND DO NOT INCLUDE ANY AMOUNTS THAT RESULT FROM INEFFICIENCIES OR POOR MANAGEMENT. IU HEALTH FRANKFORT ACCEPTS ALL MEDICARE PATIENTS KNOWING THAT THERE MAY BE SHORTFALLS; THEREFORE IT HAS TAKEN THE POSITION THAT ANY SHORTFALL SHOULD BE COUNTED AS PART OF ITS COMMUNITY BENEFIT. ADDITIONALLY, IT IS IMPLIED IN INTERNAL REVENUE SERVICE REVENUE RULING 69-545 THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENTAL HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance IU Health Frankfort's FAP and Written Debt Collection Policy describe the collection practices applicable to patients, including those who may qualify for financial assistance. 1. Financial Assistance Application Financial Assistance Applications must include the following documentation: - All sources of Income for the last three (3) months. - Most recent three (3) months of pay stubs or Supplemental Security Income via Social Security. - Most recent three (3) statements from checking and savings accounts, certificates of deposit, stocks, bonds and money market accounts. - Most recent state and Federal Income Tax forms including Schedules C, D, E, and F. In the event the patient or guarantor's income does not warrant the filing of a federal tax statement, the individual may submit a notarized affidavit attesting to the foregoing. - Most recent W-2 statement. - For patients or members of the Household who are currently unemployed, Wage Inquiry from WorkOne. - If applicable, divorce/dissolution decrees and child custody order. Patients or their guarantors wishing to apply for Financial Assistance due to Financial Hardship are encouraged to submit an Application within ninety (90) days of discharge. Patients or their guarantors may submit an Application up to two-hundred and forty (240) days from the date of their initial post-discharge billing statement from IU Health, however, accounts may be subject to Extraordinary Collection Actions (ECA) as soon as one-hundred and twenty (120) days after receipt of the initial post-discharge billing statement. Patients or their guarantors submitting an incomplete Financial Assistance Application will receive written notification of the Application's deficiency upon discovery by IU Health. The Application will be pended for a period of forty-five (45) days from the date the notification is mailed. IU Health will suspend any ECA until the Application is complete or the expiration of the forty-five (45) day period. Patients with limited English proficiency may request a copy of this Policy, a Financial Assistance Application, and a Plain Language Summary in one of the below languages: - Arabic; - Burmese; - Burmese - Falam; - Burmese - Hakha Chin; - Mandarin/Chinese; or - Spanish The patient, and/or their representative, such as the patient's physician, family members, legal counsel, community or religious groups, social services or hospital personnel may request a Financial Assistance Application be mailed to a patient's primary mailing address free of charge. IU Health maintains the confidentiality of all Financial Assistance Applications and supporting documentation. IU Health will deny or revoke Financial Assistance for any patient or guarantor who falsifies any portion of a Financial Assistance Application. 2. Financial Assistance Determinations IU Health will inform patients or guarantors of the results of their Application by providing the patient or guarantor with a Financial Assistance Determination within ninety (90) days of receiving a completed Application and all requested documentation. A patient's Financial Assistance Application and Financial Assistance Determination are specific to each date(s) of service and approved related encounters. If a patient or guarantor is granted less than full charity assistance and the patient or guarantor provides additional information for reconsideration, Revenue Cycle Services may amend a prior Financial Assistance Determination. 3. Extraordinary Collection Actions IU Health may refer delinquent patient accounts to a third-party collection agency after utilizing reasonable efforts to determine a patient's eligibility for assistance under this Policy. Reasonable efforts include the following: - IU Health will notify the patient of this Policy at least thirty (30) days prior to initiating an ECA. - IU Health will not initiate an ECA for at least one-hundred and twenty (120) days after the patient's initial post-discharge billing statement. - IU Health will review all Financial Assistance Applications received up to and including two-hundred and forty (240) days after the patient's initial post-discharge billing statement. IU Health will cease any ECAs it has initiated upon receipt of a Financial Assistance Application until a Financial Assistance Determination is made under this policy. - If an Application is Approved, IU Health will issue a revised statement, issue refunds, and make reasonable efforts to reverse ECAs as necessary. IU Health and its third-party collection agencies may initiate an ECA against a patient or their guarantor in accordance with this Policy and 26 C.F.R. § 1.501(r). ECAs may include the following: - Selling a patient or their guarantor's outstanding financial responsibility to a third party. - Reporting adverse information about the patient or their guarantor to consumer credit reporting agencies or credit bureaus. - Deferring or denying, or requiring a payment before providing, medically necessary care because of a patient or their guarantor's nonpayment of one or more bills for previously provided care covered under this Policy. - Actions requiring a legal or judicial process, including but not limited to placing a lien on a patient's or their guarantor's property, foreclosing on a patient's or their guarantor's real property, attaching or seizing a patient's or their guarantor's bank account or other personal property, commencing a civil action against a patient or their guarantor, causing a patient or guarantor's arrest, causing a patient and/or guarantor to be subject to a writ of body attachment, and garnishing a patient or guarantor's wages When it is necessary to engage in such action, IU Health and its third party collection agencies, will engage in fair, respectful and transparent collections activities. 4. Refunds Patients eligible for Financial Assistance under this Policy who remitted payment to IU Health in excess of their Patient Responsibility will be alerted to the overpayment as promptly after discovery as is reasonable given the nature of the overpayment. Patients with an outstanding account balance due on a separate account will have their refund applied to the outstanding balance. Patients without an outstanding account balance described above will be issued a refund check for their overpayment as soon as technically feasible. Schedule H, Part V, Section B, Line 16a FAP website - IU HEALTH FRANKFORT HOSPITAL: Line 16a URL: HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16b FAP Application website - IU HEALTH FRANKFORT HOSPITAL: Line 16b URL: HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - IU HEALTH FRANKFORT HOSPITAL: Line 16c URL: HTTPS://IUHEALTH.ORG/PAY-A-BILL/FINANCIAL-ASSISTANCE; Schedule H, Part VI, Line 2 Needs assessment Though IU Health Frankfort believes its CHNA process is comprehensive, the CHNA is done on a triennial basis. Between CHNA cycles, IU Health Frankfort gathers data and information to monitor the most current needs of the community. Additional sources of data and information include: * IU Health data analytics and information service teams; * Secondary data sources from Federal, state, and local entities with a focus on health behaviors, health outcomes, and social determinants of health; * Obtaining community organization and governmental agency perspectives; priority population perspectives; and other healthcare and hospital perspectives; * Reports that share findings and recommendations on certain populations within the community and/or health behaviors, health outcomes, or social determinants of health; * Evidence informed sources; and * Team member participation in partnering efforts (e.g., coalitions, advisory committees, task forces, etc.). The regular review of these sources of data and information rarely impact what the significant needs are between CHNA cycles. However, it does help influence the types or level of interventions to address the significant needs; prioritize resources to those groups or neighborhoods experiencing health disparities in the community; identify funding opportunities to support interventions; and strengthen or mobilize partnerships to improve health. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance IU Health Frankfort is committed to serving the healthcare needs of all of its patients regardless of their ability to pay for such services. To assist in meeting those needs, IU Health Frankfort has established a FAP to provide Financial Assistance to Uninsured Patients. IU Health Frankfort is committed to ensuring its patients are compliant with all provisions of the Patient Protection & Affordable Care Act. To that end, IU Health Frankfort will make a good faith effort to locate and obtain health insurance coverage for patients prior to considering patients for coverage under the FAP. IU Health Frankfort takes several measures to inform its patients of the FAP and FAP-eligibility. These measures include the following: 1. Post this Policy, a Plain Language Summary of this Policy, and the Financial Assistance Application on its website. 2. Provide patients with a Plain Language Summary of this Policy during registration and/or discharge. 3. Post conspicuous displays in appropriate acute care settings such as emergency departments and registration areas describing the available assistance and directing eligible patients to the Financial Assistance Application. 4. Include a conspicuous written notice on all patient post-discharge billing statements notifying the patient about this Policy and the telephone number of the Customer Service Department which can assist patients with questions regarding this Policy. 5. Make available Customer Service representatives via telephone during normal business hours. 6. Mail copies of this Policy, a Plain Language Summary of this Policy, and a Financial Assistance Application to patients or their guarantor free of charge upon request. 7. Broadly communicate this Policy as a part of its general outreach efforts. 8. Educate patient-facing team members on this Policy and the process for referring patients to the program. Schedule H, Part VI, Line 4 Community information IU HEALTH FRANKFORT IS LOCATED IN CLINTON COUNTY, INDIANA, A COUNTY LOCATED IN CENTRAL NORTHWEST INDIANA. CLINTON COUNTY INCLUDES ZIP CODES WITHIN THE TOWNS OF COLFAX, FOREST, FRANKFORT, KIRKLIN, MICHIGANTOWN, MULBERRY, ROSSVILLE AND SEDALIA. BASED ON THE MOST RECENT CENSUS BUREAU (2022) STATISTICS, CLINTON COUNTY'S POPULATION IS 33,188. THE COUNTY'S POPULATION ESTIMATES BY RACE ARE 80.6% WHITE, 17.1% HISPANIC OR LATINO, 1.0% BLACK, 0.5% ASIAN, 0.6% AMERICAN INDIAN OR ALASKA NATIVE, AND 1.1% PERSONS REPORTING TWO OR MORE RACES. CLINTON COUNTY HAS MODERATELY LOW LEVELS OF EDUCATIONAL ATTAINMENT. ABOUT 86.8% ATTAINED A HIGH SCHOOL DEGREE OR HIGHER. ABOUT 14.9% OF THE POPULATION OBTAINED A BACHELOR'S DEGREE OR HIGHER. Schedule H, Part VI, Line 5 Promotion of community health IU Health Frankfort is a subsidiary of IU Health, a tax-exempt healthcare organization, whose Board of Directors is composed of members, of which the majority is independent community members. IU Health and its related hospital entities across the state of Indiana, including IU Health Frankfort, extends medical privileges to all physicians who meet the credentialing qualifications necessary for appointments to its medical staff. IU Health does not deny appointments based on gender, race, creed or national origin. IU Health, in conjunction with the IU School of Medicine, trains the next generation of physicians in an exceptional environment. Blending breakthrough research and treatments with the highest quality of patient care. Schedule H, Part VI, Line 6 Affiliated health care system Indiana University Health Frankfort is part of Indiana University Health ("IU Health "the healthcare system"), which is Indiana's most comprehensive healthcare system. A unique partnership with the Indiana University School of Medicine ("IU School of Medicine"), one of the nation's leading medical schools, gives patients access to innovative treatments and therapies. The healthcare system is comprised of hospitals, physicians and allied services dedicated to providing preeminent patient care and community health improvement throughout Indiana. IU Health's affiliate hospitals are divided into five regions that serve communities in Northwest, Northeast, Central and Southern Indiana. The 16 hospitals in the healthcare system include IU Health Inc. (i.e., the IU Health Academic Health Center consists of IU Health Methodist Hospital, IU Health University Hospital, Riley Hospital for Children at IU Health and IU Health Saxony Hospital); IU Health Arnett; IU Health Ball; IU Health Bedford Hospital; IU Health Blackford Hospital; IU Health Bloomington Hospital; IU Health Frankfort; IU Health Jay; IU Health North Hospital; IU Health Paoli Hospital; IU Health Tipton Hospital; IU Health West Hospital; and IU Health White Memorial Hospital. Each affiliate hospital in the healthcare system, along with community stakeholders, conducts and adopts its own community health needs assessment (CHNA) and implementation strategy. IU Health considers the sum of these CHNAs and the implementation strategies part of a system wide vision of making Indiana one of the healthiest states in the nation. The healthcare system and its affiliate hospitals are keenly aware of the positive impact it can have on improving the health of communities throughout the state of Indiana by investing in local, community-based activities. The healthcare system includes an Academic Health Center (i.e., IU Health Inc.), a regional academic health center (i.e., IU Health Bloomington Hospital) and several affiliate hospitals that work in partnership with the IU School of Medicine to train physicians, blending breakthrough research and treatments with the highest quality of patient care throughout IU Health. Each year, more than 1,000 residents and fellows receive training in affiliate hospitals. Research conducted by IU School of Medicine faculty gives IU Health physicians and patients access to the most leading-edge and comprehensive treatment options. To further promote the health of the communities served by IU Health, the system-level Community Health Division team partners with state and local community-based organizations, community coalitions and governmental agencies to focus on innovative models of care; community alliances and partnerships; anchor institution and advocacy strategies; and social determinants of health. All affiliate hospitals in the healthcare system identify and address significant needs unique to the communities they serve. These needs are identified through the CHNA process. Some of these needs are common in communities served by multiple affiliate hospitals in the healthcare system and align with system priority areas, warranting a system level strategy. The Community Health Division, along with additional internal stakeholders such as the Office of Health Equity Research and Evaluation, plans and provides technical assistance for system-level strategies that address these common needs including health equity, tobacco, behavioral health access, infant and maternal health, hypertension, and social determinants of health. Each affiliate hospital works collaboratively with the Community Health Division to align and activate local resources to support these strategies. This benefits the community each affiliate hospital serves and works towards a statewide impact (system-level) on health outcomes. As part of the Community Health Division, Community Outreach and Engagement Program's IU Health Serves, a system-level team member volunteer program, seeks to positively impact the health of communities IU Health affiliate hospitals serve and foster a culture of engagement and social responsibility. Each affiliate hospital coordinates the different initiatives of the program, including Days of Service. This is the largest volunteer event of the year, consisting of projects designed to engage each affiliate hospitals' team members in activities that address local, significant needs. The Community Impact and Investment (CII) Fund is a $200 million dollar board designated fund that is managed by the IU Health Foundation to financially support high impact community investing. The focus of these efforts will address social determinants of health and health disparities that impact marginalized and minoritized populations in the communities IU Health serves. Through the grants provided by this CII Fund, IU Health can strategically and intentionally address the social, economic, and environmental factors that impact the health of affiliate hospitals' surrounding communities. Each affiliate hospital and its team members are eligible to pursue this grant opportunity with a community organization or agency. Schedule H, Part VI, Line 7 State filing of community benefit report IN true true false false false false false true false RUBAN NIRMALAN MD DIRECTOR 0 328044 0 462032 0 16089 0 10958 0 49164 0 866287 0 0 WILLIAM Y LI MD DIRECTOR 0 236088 0 97875 0 2322 0 12200 0 25239 0 373724 0 0 MICHELE S SAYSANA MD DIRECTOR 0 515754 0 51401 0 2810 0 4333 0 15410 0 589708 0 0 ERIKA UGIANSKIS MD DIRECTOR 0 477683 0 73763 0 187826 0 12200 0 61927 0 813399 0 0 MARK BUONO MD Director 0 580797 0 75250 0 3564 0 9586 0 41653 0 710850 0 0 CARA L BREIDSTER FORMER OFFICER 0 277473 0 36663 0 23994 0 12119 0 54533 0 404782 0 0 DEREK E EMPIE FORMER OFFICER 0 285471 0 24754 0 1242 0 12200 0 49637 0 373304 0 0 DANIEL E NEUFELDER FORMER OFFICER 0 0 0 188587 0 0 0 0 0 0 0 188587 0 0 ARTHUR VASQUEZ REGIONAL PRESIDENT (WCR) 0 500988 0 89248 0 1869 0 88651 0 34029 0 714786 0 0 TODD A WILLIAMS CFO/TREASURER (WCR) 0 279626 0 29218 0 22822 0 12173 0 55155 0 398994 0 0 PHILIP LIST SECRETARY (WCR) 0 164687 0 18161 0 294 0 7651 0 38887 0 229680 0 0 KRISTIN POST INTERIM PRESIDENT (PART YEAR) 0 164748 0 15328 0 1433 0 7424 0 30004 0 218936 0 0 CHRISTOPHER A MANSFIELD MD VP-CMO (WCR) 0 387881 0 122976 0 8232 0 12200 0 54970 0 586259 0 0 JEFFREY C ZEH COO (WCR) 0 318873 0 31441 0 17229 0 12057 0 27227 0 406827 0 0 KOREEN C KYHNELL VP - HUMAN RESOURCES (WCR) 0 187140 0 20092 0 21933 0 10677 0 57064 0 296906 0 0 ALLISON SHUTTZ CNO (PART YEAR) 0 221295 0 24469 0 204450 0 10131 0 41086 0 501432 0 0 KISHAN PATEL MD VP-Chief Physician Executive (WCR) (Part Year) 0 387221 0 23918 0 540 0 12200 0 28597 0 452475 0 0 JAMES H PARSONS FORMER HIGHEST COMPENSATED EMPLOYEE 0 173618 0 18096 0 378 0 8209 0 37906 0 238208 0 0 LAWRENCE STAUFFER FORMER HCE 0 144112 0 12386 0 5231 0 6763 0 40085 0 208576 0 0 TRACY MOORE Therapist-Respiratory Registered 120823 0 11872 0 2577 0 5544 0 30738 0 171554 0 0 0 CHRISTEN N BARKER Clinical Nurse 108466 0 37844 0 744 0 5970 0 30469 0 183493 0 0 0 JERRY W DRUMMOND Technologist-Diagnostic Radiology Advanced 129051 0 58091 0 0 0 7449 0 11174 0 205765 0 0 0 JAN EARLY Therapist-Respiratory Registered 129155 0 10255 0 469 0 5667 0 16117 0 161663 0 0 0 MACEY PARKER CLINICAL NURSE 109717 0 46259 0 1806 0 4183 0 9727 0 171692 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation IU HEALTH FRANKFORT'S REGIONAL PRESIDENT IS EMPLOYED BY IU HEALTH, INC. IU HEALTH, INC., IU HEALTH FRANKFORT, AND OTHER RELATED ENTITIES HAVE A PROCESS IN PLACE TO DETERMINE THE COMPENSATION FOR THE OTHER OFFICERS AND KEY EMPLOYEES. IU HEALTH HUMAN RESOURCES USES MARKET DATA FROM MULTIPLE COMPENSATION EXPERTS/VENDORS WHO UTILIZE A VARIETY OF METHODS AND PROCEDURES TO OBTAIN COMPENSATION RANGES FOR COMPARABLE OFFICER AND EMPLOYEE POSITIONS. THIS MARKET DATA AND MULTIPLE OTHER FACTORS (INCLUDING MARKET PAY BENCHMARKS, INTERNAL EQUITY, CANDIDATE/EMPLOYEE QUALIFICATIONS & PERFORMANCE, AND BUSINESS NEEDS) ARE USED TO RECOMMEND COMPENSATION RANGES FOR ITS OFFICERS AND OTHER EMPLOYEES, WHICH ARE THEN USED AS A GUIDE FOR SETTING REASONABLE COMPENSATION BY MANAGEMENT. PLEASE SEE SCHEDULE O FOR ADDITIONAL DETAILS. Schedule J, Part I, Line 4a Severance or change-of-control payment ALLISON SHUTTZ ENTERED INTO A SEVERANCE AGREEMENT WITH IU HEALTH ARNETT DURING 2022. SHE RECEIVED SEVERANCE OF $203,980 DURING 2022. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan ARTHUR VASQUEZ PARTICIPATES IN AN IU HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN, PROVISIONS OF WHICH ARE DESIGNED TO RETAIN ITS CRITICAL EMPLOYEES. THE PLAN PROVIDES FOR AN ADDITIONAL RETIREMENT BENEFIT FOR SERVICE THROUGH NORMAL RETIREMENT OR OTHER KEY DATES. IF THE EXECUTIVE LEAVES PRIOR TO RETIREMENT OR OTHER KEY DATES, THE BENEFIT MAY BE FORFEITED OR REDUCED. ARTHUR VASQUEZ HAS AN AMOUNT INCLUDED IN COLUMN C, DEFERRED COMPENSATION, REPRESENTING THE CURRENT YEAR UNVESTED CONTRIBUTIONS MADE UNDER THE SUPPLEMENTAL RETIREMENT PLAN. NO AMOUNTS WERE ACTUALLY PAID TO THIS EXECUTIVE DURING THE YEAR. Schedule J, Part I, Line 7 Non-fixed payments AMOUNTS DISCLOSED IN COLUMN B(II) INCLUDE A LONG-TERM AND SHORT-TERM INCENTIVE FOR CERTAIN EXECUTIVES AND SHORT-TERM INCENTIVE FOR OTHER EMPLOYEES. ALTHOUGH THESE PLANS ARE BASED ON A FIXED FORMULA THAT HAS BEEN APPROVED BY THE BOARD OF DIRECTORS BASED UPON CERTAIN QUALITATIVE AND QUANTITATIVE FACTORS AND GOALS, ALL DISCRETIONARY INCENTIVE PLANS MUST BE APPROVED BY THE TALENT MANAGEMENT AND EXECUTIVE COMPENSATION COMMITTEE AND BOARD OF DIRECTORS PRIOR TO ANY INCENTIVE PAYOUT. Form 990, Part VI, Line 13 SECTION B, LINES 12, 13, 14, AND 16B - POLICIES IU HEALTH FRANKFORT IS PART OF THE IU HEALTH SYSTEM. AS THE SOLE MEMBER AND CONTROLLING PARENT OF IU HEALTH FRANKFORT, IU HEALTH AND ITS BOARD OF DIRECTORS HAVE MANDATED THAT CERTAIN POLICIES BE FOLLOWED TO ENSURE GREATER STANDARDIZATION THROUGHOUT THE SYSTEM. THUS, IU HEALTH FRANKFORT'S BOARD OF DIRECTORS WAS NOT REQUIRED TO SEPARATELY ADOPT A CONFLICT OF INTEREST, WHISTLEBLOWER, DOCUMENT RETENTION AND DESTRUCTION AND JOINT VENTURE POLICIES BECAUSE IU HEALTH'S BOARD OF DIRECTORS HAD ALREADY ADOPTED AND REQUIRED THESE POLICIES TO BE FOLLOWED BY ITS SUBSIDIARIES. Form 990, Part VI, Line 15 PROCESS FOR DETERMINING COMPENSATION IU HEALTH FRANKFORT'S REGIONAL PRESIDENT IS EMPLOYED BY IU HEALTH, INC. IU HEALTH FRANKFORT'S PRESIDENT IS EMPLOYED BY IU HEALTH FRANKFORT. IU HEALTH'S PROCESS FOR DETERMINING COMPENSATION AS FOLLOWS: (1) THE BOARD OF DIRECTORS ("BOARD") HAS ESTABLISHED A TALENT MANAGEMENT AND EXECUTIVE COMPENSATION COMMITTEE ("TMECC"), THE PURPOSE OF WHICH INCLUDES REVIEWING AND MAKING RECOMMENDATIONS REGARDING EXECUTIVE (SENIOR VICE PRESIDENTS AND ABOVE) PAY AND BENEFITS (COLLECTIVELY REFERRED TO AS "COMPENSATION") ON AN ANNUAL BASIS IN APRIL. THE TMECC IS MADE UP OF MEMBERS OF THE BOARD THAT ARE NEITHER PHYSICIANS NOR EMPLOYEES AND DO NOT OTHERWISE HAVE A CONFLICT OF INTEREST REGARDING ANY OF IU HEALTH'S COMPENSATION ARRANGEMENTS. THE TMECC REVIEWS AN EXECUTIVE'S ENTIRE COMPENSATION PACKAGE INCLUDING BASE SALARY, SHORT-TERM AND LONG-TERM INCENTIVES, HEALTH AND WELFARE BENEFITS, QUALIFIED AND NONQUALIFIED RETIREMENT PLANS, AS WELL AS ANY ADDITIONAL FRINGE BENEFITS. AS DEEMED APPROPRIATE, THE COMMITTEE ON FINANCE, WHICH IS ALSO MADE UP OF MEMBERS OF THE BOARD, MAY ALSO REVIEW EXECUTIVE COMPENSATION AND BENEFITS. (2) THE TMECC ENGAGES AN INDEPENDENT COMPENSATION CONSULTING FIRM ON AN ANNUAL BASIS TO CONDUCT A COMPENSATION ANALYSIS FOR ITS EXECUTIVE GROUP, WHICH CONSISTS OF EMPLOYEES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. THE CURRENT COMPENSATION ADVISOR IS SULLIVANCOTTER. SULLIVANCOTTER PERFORMS ITS ANALYSIS IN THE FORM OF A COMPENSATION SURVEY ("SURVEY") THAT INCLUDES RELEVANT COMPARABILITY DATA FOR COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS (BOTH GOVERNMENTAL AND TAX EXEMPT) FOR FUNCTIONALLY COMPARABLE POSITIONS AS WELL AS THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA. SULLIVANCOTTER THEN PREPARES A SURVEY REPORT AND PROVIDES RECOMMENDATIONS TO THE TMECC, IF DEEMED APPROPRIATE, ON CHANGES IN EXECUTIVE COMPENSATION. A SEPARATE ANALYSIS USING THE SAME METHODOLOGY IS DONE FOR THE PRESIDENT AND CHIEF EXECUTIVE OFFICER. (3) THE TMECC THEN REVIEWS SULLIVANCOTTER'S REPORT AND RECOMMENDATIONS AND, IF APPROPRIATE, VOTES ON WHETHER TO RECOMMEND ANY CHANGES IN EXECUTIVE COMPENSATION TO THE BOARD. THE TMECC WILL ONLY RECOMMEND CHANGES TO THE BOARD IF THEY ARE CONSISTENT WITH THE BOARD'S PHILOSOPHY ON COMPENSATION MATTERS AND ARE DEEMED REASONABLE BASED UPON THE INDEPENDENT ANALYSIS PROVIDED BY SULLIVAN COTTER. THE TMECC'S REVIEW, DISCUSSION AND VOTE ARE DOCUMENTED IN THE MINUTES FOR THE MEETING. THERE ARE NO EXECUTIVES PRESENT DURING THE FINAL DISCUSSION AND APPROVAL. (4) THE BOARD THEN REVIEWS THE REPORT PREPARED BY SULLIVANCOTTER AS WELL AS THE RECOMMENDATIONS OF THE TMECC AS TO ANY CHANGES IN EXECUTIVE COMPENSATION. AS DEEMED APPROPRIATE, THE COMMITTEE ON FINANCE MAY ALSO PROVIDE ITS REVIEW OF THE TMECC'S RECOMMENDATIONS ON ANY CHANGES IN EXECUTIVE COMPENSATION. THIS REVIEW AND DISCUSSION ARE DOCUMENTED IN THE MINUTES. (5) THE BOARD THEN VOTES ON WHETHER TO ACCEPT THE TMECC'S RECOMMENDATIONS ON ANY CHANGES IN EXECUTIVE COMPENSATION. CHANGES IN EXECUTIVE COMPENSATION ARE MADE IF APPROVED BY THE TMECC AND BOARD ON AN ANNUAL BASIS, OR AS NECESSARY THROUGHOUT THE YEAR. THE DISCUSSION AND APPROVAL ARE DOCUMENTED IN THE MINUTES OF THE MEETING. THERE ARE NO EXECUTIVES PRESENT DURING THE FINAL DISCUSSION AND APPROVAL. IU HEALTH'S GENERAL COUNSEL ALSO PREPARES A FORMAL WRITTEN OPINION REVIEWING THE EXECUTIVE COMPENSATION APPROVAL PROCESS, COMPARING IT TO THE INTERMEDIATE SANCTIONS TEST OF IRC SECTION 4958. IF WARRANTED, IU HEALTH'S GENERAL COUNSEL MAY ALSO PROVIDE COMMENTS REGARDING THE EXECUTIVE COMPENSATION APPROVAL PROCESS AS IT RELATES TO MEETING THE REQUIREMENTS FOR A REBUTTABLE PRESUMPTION OF REASONABLENESS AS PROVIDED IN THE INTERMEDIATE SANCTIONS TEST. (6) AFTER THE END OF EACH YEAR, THE TMECC AND BOARD ALSO REVIEW THE ACHIEVEMENTS OF THE EXECUTIVE GROUP AS IT RELATES TO THE LONG-TERM AND SHORT-TERM SHARED AND INDIVIDUAL GOALS DEVELOPED BY THE EXECUTIVES AND THE BOARD. THESE ACHIEVEMENTS MAY ALSO BE REVIEWED WITH THE COMMITTEE ON FINANCE. THE BOARD, AT ITS DISCRETION, MAY APPROVE BONUS PAYMENTS BASED UPON THE ACHIEVEMENT OF THE GOALS. THE DISCUSSION AND VOTE OF THE TMECC AND BOARD IS DOCUMENTED IN THE MINUTES FOR EACH SUCH MEETING. THE BONUSES ARE NOT PAID UNTIL APPROVAL IS MADE BY THE BOARD. (7) THE TMECC AND AUDIT COMMITTEE ALSO REVIEW FORM 990 DISCLOSURES RELATED TO EXECUTIVE COMPENSATION AS WELL AS THE ORGANIZATION'S PRACTICES AND APPROVAL PROCESSES PRIOR TO THE FILING OF THE FORM 990 RETURN WITH THE INTERNAL REVENUE SERVICE. IU HEALTH FRANKFORT AND OTHER RELATED ENTITIES HAVE A PROCESS IN PLACE TO DETERMINE THE COMPENSATION FOR THE OTHER OFFICERS AND KEY EMPLOYEES. IU HEALTH HUMAN RESOURCES USES MARKET DATA FROM MULTIPLE COMPENSATION EXPERTS/VENDORS WHO UTILIZE A VARIETY OF METHODS AND PROCEDURES TO OBTAIN COMPENSATION RANGES FOR COMPARABLE OFFICER AND EMPLOYEE POSITIONS. THIS MARKET DATA AND MULTIPLE OTHER FACTORS (INCLUDING MARKET PAY BENCHMARKS, INTERNAL EQUITY, CANDIDATE/EMPLOYEE QUALIFICATIONS & PERFORMANCE, AND BUSINESS NEEDS) ARE USED TO RECOMMEND COMPENSATION RANGES FOR ITS OFFICERS AND OTHER EMPLOYEES, WHICH ARE THEN USED AS A GUIDE FOR SETTING REASONABLE COMPENSATION BY MANAGEMENT. REASONABLE COMPENSATION BY MANAGEMENT. Form 990, Part VI, Line 6 Classes of members or stockholders THE SOLE MEMBER OF IU HEALTH FRANKFORT, INC. IS INDIANA UNIVERSITY HEALTH, INC. ("IU HEALTH"), A 501(C)(3) TAX-EXEMPT ORGANIZATION. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE BOARD OF DIRECTORS OF IU HEALTH FRANKFORT SHALL CONSIST OF UP TO FOURTEEN (14) VOTING MEMBERS ALL APPOINTED BY IU HEALTH, WHO SHALL INCLUDE UP TO TWO (2) DIRECTORS WHO RESIDE IN CLINTON COUNTY AND FOUR (4) PHYSICIAN REPRESENTATIVES FROM THE WEST CENTRAL REGION. THE PHYSICIAN DIRECTORS WILL BE IDENTIFIED THROUGH A NOMINATION PROCESS DEVELOPED BY THE WEST CENTRAL REGION AND SUBMITTED TO IU HEALTH FOR CONSIDERATION AND APPROVAL. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders THE FOLLOWING ARE SUBJECT TO IU HEALTH'S APPROVAL: - ANY PROPOSED AMENDMENT TO THE CORPORATION'S ARTICLES OF INCORPORATION OR THESE BYLAWS; - ADOPTION OF THE CORPORATION'S ANNUAL CAPITAL AND OPERATING BUDGETS; - APPROVAL OF ANY UNBUDGETED OPERATING OR CAPITAL BUDGET ITEMS OR DEVIATIONS, INCLUDING ANY ISSUANCE OR GUARANTEE OF ANY UNBUDGETED DEBT; - APPROVAL OF ANY STRATEGIC PLAN FOR THE CORPORATION, INCLUDING ANY AMENDMENTS TO A STRATEGIC PLAN; - APPROVAL OF ANY ENCUMBRANCE, SALE OR CONVEYANCE OF ASSETS; - ANY MERGER, CONSOLIDATION, JOINT VENTURE OR AFFILIATION INVOLVING THE CORPORATION OR ANY OF ITS AFFILIATES AND ANY OTHER ENTITY; - APPOINTMENT AND REMOVAL OF THE CORPORATION'S PRESIDENT AND OTHER OFFICERS; - CONSTRUCTION, ACQUISITION OR LEASE OF HOSPITAL BUILDINGS; - PROJECTS OR CONTRACTS THAT REQUIRE MEMBER APPROVAL IN ACCORDANCE WITH THE MEMBER'S RESOLUTION AND POLICY GOVERNING SYSTEM-WIDE CONTRACT EXECUTION AUTHORITY AND PAYMENT APPROVAL LIMITS; AND - THE DISSOLUTION OF THE CORPORATION OR ANY OF ITS AFFILIATES. Form 990, Part VI, Line 11b Review of form 990 by governing body THE CFO REVIEWED AND APPROVED THE FORM 990. FOLLOWING THEIR REVIEW AND APPROVAL, A COMPLETE COPY OF THE FORM 990 WAS MADE AVAILABLE TO EACH BOARD MEMBER PRIOR TO ITS FILING. EACH MEMBER WAS ALSO INFORMED OF THE AVAILABILITY OF IU HEALTH'S TAX DEPARTMENT TO ANSWER ANY QUESTIONS. Form 990, Part VI, Line 12c Conflict of interest policy IU HEALTH FRANKFORT FOLLOWS IU HEALTH'S CONFLICT OF INTEREST POLICY. IU HEALTH'S CONFLICT OF INTEREST POLICY INCLUDES THE FOLLOWING PROVISIONS: ALL IU HEALTH EMPLOYEES, ASSOCIATES, COLLEAGUES AND CONTRACTED PERSONNEL, INCLUDING EMPLOYED PHYSICIANS AND PAID MEDICAL DIRECTORS ("IU HEALTH REPRESENTATIVES") ARE COVERED BY AND SUBJECT TO ITS CONFLICT OF INTEREST POLICY. IU HEALTH REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE POLICY THROUGH THE FOLLOWING PROCEDURES: (A) ON AN ANNUAL BASIS, EACH IU HEALTH REPRESENTATIVE AT THE LEVEL OF MANAGER OR ABOVE, TOGETHER WITH EVERY OTHER PERSON DESIGNATED BY THE CORPORATE COMPLIANCE DEPARTMENT ("DEPARTMENT"), MUST COMPLETE, SIGN AND SUBMIT A CONFLICT OF INTEREST QUESTIONNAIRE ("QUESTIONNAIRE") TO THE DEPARTMENT. GOVERNING BOARD MEMBERS, COMMITTEE MEMBERS, CORPORATE OFFICERS, MEDICAL STAFF AND RESEARCHERS MUST COMPLY WITH THE ADMINISTRATIVE REQUIREMENTS NOTED IN THE RESPECTIVE POLICIES AND PROCEDURES RELATIVE TO THOSE AREAS. (B) AN IU HEALTH REPRESENTATIVE MUST SUPPLEMENT A QUESTIONNAIRE IN WRITING, IF AFTER COMPLETION OF THE ORIGINAL QUESTIONNAIRE, A SITUATION ARISES, OR MAY REASONABLY BE EXPECTED TO ARISE, THAT WOULD CHANGE ANY ANSWER OR INFORMATION ON THE ORIGINAL QUESTIONNAIRE IF THE SITUATION HAD EXISTED OR BEEN ANTICIPATED AT THE TIME OF COMPLETION OF THE ORIGINAL QUESTIONNAIRE. (C) IF A FULLY AND PROPERLY COMPLETED QUESTIONNAIRE REVEALS FACTS OR OTHER INFORMATION THAT MIGHT REASONABLY INDICATE A CONFLICT OF INTEREST OR VIOLATION OF THE POLICY, THE IU HEALTH REPRESENTATIVE COMPLETING THE QUESTIONNAIRE MUST SECURE APPROVAL BY HIS/HER SUPERVISOR, EVIDENCED IN WRITING. (D) THE DEPARTMENT WILL REVIEW EACH QUESTIONNAIRE AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS AND, IF SO, WHETHER AND HOW IT SHOULD OR MAY BE ELIMINATED, AVOIDED OR MANAGED IN ORDER TO COMPLY WITH THE SPIRIT OF THE POLICY AND WITH THE BEST INTERESTS OF IU HEALTH AND ITS PATIENTS. IN MAKING THE DETERMINATION, THE CORPORATE COMPLIANCE DEPARTMENT MAY CONSULT WITH THE IU HEALTH REPRESENTATIVE'S SUPERVISOR AND OTHER APPROPRIATE INDIVIDUALS AND GROUPS. (E) THE SCOPE OF THE POLICY IS NOT LIMITED TO THOSE WHO ARE REQUIRED TO COMPLETE QUESTIONNAIRES. IF AN IU HEALTH REPRESENTATIVE IS INVOLVED IN A SITUATION OR RELATIONSHIP THAT WOULD CONSTITUTE A VIOLATION OF THE POLICY IN THE ABSENCE OF DISCLOSURE AND APPROVAL AS DESCRIBED ABOVE, THEN THE IU HEALTH REPRESENTATIVE MUST DISCLOSE THE MATTER TO HIS/HER SUPERVISOR, SECURE HIS/HER SUPERVISOR'S APPROVAL IN WRITING, AND DISCLOSE THE MATTER TO THE DEPARTMENT. OTHERWISE, THE IU HEALTH REPRESENTATIVE IS IN VIOLATION OF THE POLICY AND SUBJECT TO CORRECTIVE ACTION, UP TO AND INCLUDING TERMINATION. (F) THE CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH ONSITE COMPLIANCE PERSONNEL, MAY FROM TIME TO TIME APPOINT STANDING OR AD HOC COMMITTEES TO ASSIST IN RESOLVING ISSUES THAT ARISE UNDER PROVISIONS OF THE POLICY. Form 990, Part VI, Line 19 Required documents available to the public IU HEALTH FRANKFORT'S ARTICLES OF INCORPORATION ARE AVAILABLE FOR PUBLIC INSPECTION THROUGH THE INDIANA SECRETARY OF STATE'S WEBSITE. IU HEALTH FRANKFORT'S CONFLICT OF INTEREST PROCEDURES ARE DESCRIBED ON FORM 990, SCHEDULE O. IU HEALTH FRANKFORT IS A SUBSIDIARY IN IU HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS. IU HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE AVAILABLE FOR PUBLIC INSPECTION THROUGH ITS BOND FILINGS AND AS AN ATTACHMENT TO IU HEALTH'S FORM 990 AS WELL AS IU HEALTH FRANKFORT'S FORM 990. Form 990, Part IX, Line 11g Other Fees Intercompany fees - Total Expense: 8050346, Program Service Expense: 7400095, Management and General Expenses: 650251, Fundraising Expenses: ; Physician fees - Total Expense: 798787, Program Service Expense: 734267, Management and General Expenses: 64520, Fundraising Expenses: ; Contract service - Total Expense: 432823, Program Service Expense: 397863, Management and General Expenses: 34960, Fundraising Expenses: ; Professional fees - Total Expense: 120926, Program Service Expense: 111158, Management and General Expenses: 9768, Fundraising Expenses: ; Fees - other services - Total Expense: 25213, Program Service Expense: 23176, Management and General Expenses: 2037, Fundraising Expenses: ; Consulting - Total Expense: 13319, Program Service Expense: 12243, Management and General Expenses: 1076, Fundraising Expenses: ; INDIANA HEALTH INFO EXCHANGE INC 846 N SENATE AVE INDIANAPOLIS IN 46202 364550324 HEALTHCARE IN 501(c)(3) Type I NA false IU HEALTH 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